Newborn Breathing Conditions Bronchopulmonary Dysplasia (BPD)

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BPD is a serious lung condition that affects newborns. Most newborns who develop BPD are born more than 10 weeks before their due dates, weigh less than 2 pounds at birth, and have breathing problems.

Babies are not born with BPD. Instead, they develop it as a complication of another breathing condition. For example, most babies who develop BPD are born with respiratory distress syndrome (RDS). However, other types of newborn breathing conditions, infections, and lung injuries from treatments like mechanical ventilation can also lead to BPD.

Newborns are diagnosed with BPD if they still need breathing support 28 days after birth, or around the time they would have reached their original due date.

BPD can lead to many health problems such as:

• Trouble feeding that may result in needing a feeding tube
• Gastroesophageal reflux disease (GERD), which occurs when the acid in the stomach flows backwards into the tube that connects the mouth to the stomach (called the esophagus)
• Pulmonary hypertension, which is increased pressure in the blood vessel that carries blood from the heart to the lungs, called the pulmonary artery
• Delayed speech and problems with vision and hearing
• Learning difficulties
• Heart defects like patent ductus arteriosus
• Infections, like sepsis

BPD is the result of a newborn's lungs not developing normally while the baby is growing in the womb, or not developing fully if the baby was born premature. Babies with BPD have fragile lungs that can be easily irritated or inflamed after birth.

There are many factors that can raise a baby’s risk of developing BPD, including:

• Premature delivery, which raises the risk of respiratory distress syndrome
• Long-term treatment for breathing issues such as mechanical ventilation and supplemental oxygen, which can damage the lungs
• Infections, such as sepsis
• inflammation of the lungs present before birth, possibly due to a bacterial infection of the placenta called chorioamnionitis

The best way to treat BPD is to find the underlying cause and treat that if possible. In the meantime, your baby’s healthcare team will provide breathing support and minimize lung damage as much as possible.

Treatments include those listed below.

• Nasal continuous positive airway pressure (nCPAP): This device provides breathing support by gently pushing air into the baby's lungs through prongs placed in the nose.
• Surfactant replacement therapy: This can be used if a newborn struggles to breathe despite the use of nCPAP. Sometimes, giving an infant surfactant requires the use of a breathing tube. If so, because of the possible complications, your baby’s provider will help you consider the risks and benefits of the procedure.
• Medicines: Diuretics, bronchodilators, and caffeine can be used with treatments that support breathing.

Most babies improve gradually in the 2 to 4 months that follow a diagnosis of BPD. Once lung function improves to where a baby can breathe on their own, they can be weaned off breathing support and other treatments.

Some babies may be able to leave the hospital but could still require supportive breathing treatments given at home. Before a baby leaves, it is important that they are up to date on all vaccinations since they are especially vulnerable to viral infections, which could require rehospitalization.

Depending on the severity of BPD, lifelong breathing problems are possible. Children and adults that had BPD as babies may have reduced lung function. This can cause symptoms like wheezing and shortness of breath that can make activities, like exercise, difficult.